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Naupliar development in copepods includes the generation of usually five pairs of post-mandibular segments. Since copepod nauplii show no outer body articulation, the only indication of larval segmentation is the expression of limb buds. Yet, in copepods the timing and sequence of limb bud expression in larval development varies to a large degree. In harpacticoid nauplii for instance, the 1st maxillae are formed at an early naupliar stage. By contrast, the four remaining pairs of limb buds frequently appear simultaneously with the last naupliar stage. The complete process of larval segment formation takes place under the body surface and has never been described in detail. To broaden our knowledge of early segmentation in copepods, we here describe the segmentation of the harpacticoid nauplius Tigriopus californicus by analysing the expression of the segment marker Engrailed and uncover the sequential addition of seven post-mandibular segments. The stripe formation and arrangement of labelled cells corresponds largely to those of other crustaceans studied in this respect. Together with a morphological approach using histology, SEM, and 3D-reconstructions based on CLSM we solve the so far controversial identity of the external limb buds in the final naupliar stage. In contrast to previous studies, we can show that all limb pairs from the 1st maxillae to the 3rd thoracopods are formed. Yet, the anlage of the maxilliped (1st thoracopod) remains hidden underneath the cuticle being never externally expressed in the nauplius.

The management of Helicobacter pylori negative patients with dyspepsia in primary care has not been studied in placebo-controlled studies.H. pylori negative patients with dyspepsia symptoms of at least moderate severity (or =4 on a seven-point Likert scale) were recruited from 35 centers. Patients were randomized to a 4-wk treatment of omeprazole 20 mg od, ranitidine 150 mg bid, cisapride 20 mg bid, or placebo, followed by on-demand therapy for an additional 5 months. Treatment success was defined as no or minimal symptoms (scoreor = 2 out of 7), and was assessed after 4 wk and at 6 months.Five hundred and twelve patients were randomized and included in the intention-to-treat (ITT) analysis. At 4 wk, success rates (95% CI) were: omeprazole 51% (69/135; 43-60%), ranitidine 36% (50/139, 28-44%), cisapride 31% (32/105, 22-39%), and placebo 23% (31/133, 16-31%). Omeprazole was significantly better than all other treatments (p0.05). The proportion of patients who were responders at 4 wk and at 6 months was significantly greater for those receiving omeprazole 31% (42/135, 23-39%) compared with cisapride 13% (14/105, 7-20%), and placebo 14% (18/133, 8-20%) (p= 0.001), but not ranitidine 21% (29/139, 14-27%) (p= 0.053). The mean number of on-demand study tablets consumed and rescue antacid used was comparable across groups. Economic analysis showed a trade-off between superior efficacy and increased cost between omeprazole and ranitidine.Treatment with omeprazole provides superior symptom relief compared to ranitidine, cisapride, and placebo in the treatment of H. pylori negative primary care dyspepsia patients.

Summary Background : There are few data on empiric, stepped therapy for heartburn relief or subsequent relapse in primary care. Aims : To compare heartburn relief produced by a proton pump inhibitor-start or an H2-receptor antagonist-start with step-up therapy, as needed, followed by a treatment-free period to assess relapse. Methods : Heartburn-dominant uninvestigated dyspepsia patients from 46 primary care centres were randomized to one of two active treatment strategies: omeprazole 20 mg daily (proton pump inhibitor-start) or ranitidine 150 mg bid (H2-receptor antagonist-start) for the first 4–8 weeks, stepping up to omeprazole 40 or 20 mg daily, respectively, for 4–8 weeks for persistent symptoms. Daily diaries documented heartburn relief (score ≤3/7 on ≤1 of 7 prior days) and relapse (score ≥4 on ≥2 of 7 prior days). Results : For ‘proton pump inhibitor-start’ (n = 196) vs. ‘H2-receptor antagonist-start’ (n = 194), respectively, heartburn relief occurred in 55.1% vs. 27.3% (P